Child Psych Assessment

7/29/2019 Child Psych Assessment

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Introduction to PsychologicalAssessment of Children

Gregg Selke, Ph.D.

PSY 4930October 3, 2006


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Purpose of Psych. Assessment

Goal Driven

Broad Screening versus Focused/Problem-

Specific Diagnostic

Differential and Comorbid Conditions

Therapy Oriented

Identify target problems Develop preliminary intervention plan

Progress evaluation How well are ongoing interventions working?


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Testing vs. Assessment

Both involve Identifying areas of concern

Collecting data

Psychological Testing Administering tests

Focuses solely on collection of data

Psychological Assessment More broad goals

Involves several clinical tools

Uses clinical skill to interpret data and synthesize

results


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Psychological Testing

Require standardized proceduresforbehavior measurement

Consistency and use of the same Item content

Administration procedures

Scoring criteria

Designed to reduce personal differencesand biases of examiners and other externalinfluences on the childs performance


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Psychological Assessment

Main types of assessment

1. Norm-referenced tests

2. Interviews

3. Observations

4. Informal assessment procedures

5. Non-norm referenced tests


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Norm-Referenced Tests

Tests that are standardized on a clearlydefined group Normative versus clinical reference groups

Goal: quantify the childs functioning Scores represent a rank within the comparison

group Examples

Intelligence Academic skills Neurocognitive skills Motor skills

Behavioral and emotional functioning


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Psychometric properties

Demographically representative standardizationsample

Reliability

Internal consistency, test-retest stability

Validity

Correlation with other tests measuring same construct

Ecological

Psychological tests are imperfect

Examiner, the child, and the environment can

affect responses and scores


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Most attempt to be normally distributed

Standard deviation: Commonly used measure of theextent to which scores deviate from the mean

In a Normal distribution, 68% of cases fall between 1 SDabove the mean and 1 SD below the mean

The threshold for meeting clinical significance variesacross tests, typically > 1 to 2 SDs above or below mean

Normal or Bell curve


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Percentile ranks

Determines childs position relative to thecomparison group

Example: What does it mean when a child is inthe 35th %tile on an Intelligence test??

Age-Equivalent and Grade-Equivalent scores

Frequently used on academic achievement tests Sometimes questionable validity


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Variables Affecting Test Scores

Demand characteristics

Child may give a certain type of response

in order to obtain a desired outcome Response bias

Childs response to one item may influence

how they respond to subsequent items Social desirability

Tendency to present ones self in a positive

light


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Misinterpretation of Items Misunderstanding directions

Format of instructions Oral vs. written

Response format True-false, written, oral, timed, untimed

Setting variables Location, time of day, medication status

Previous testing experience Practice effects


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Reactive effects

Assessment procedure affects responses

Timed, anxiety provoking Examiner-examinee variables

Individual characteristics may affect

responses (e.g., gender, age, warmth) Research suggests that children of low SES

and/or ethnic minorities are more affectedby examiner characteristics

Familiar vs. unfamiliar examiner


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Administering Tests

Administering psychological tests tochildren requires specific skills

Flexibility: breaks, time to warm up,establishing rapport

Vigilance: attend to childs behavior whilestill correctly administering the test

Self-awareness: how do children typicallyreact to your style, body language,mannerisms


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Examiner Nonverbal Behavior

Positive Behaviors Negative Behaviors

Good eye contact Avoiding eye contact,staring or peering

Body postureleaningtowards child

Body posture - laid back,feet propped up

Interested, natural voice Interrupting child often

Not engaging in distracting

gestures

Looking at watch, chewing

gum, running handsthrough hair, etc.

Taking minimal notes whilecontinuing to make

frequent eye contact

Taking excessive notes andseldom looking at child


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Other Testing Issues

Introducing yourself to child

Explaining what the child will be doing

Letting them know where their parent will beduring the assessment

Providing adequate expectations

Developmental considerations

Younger children Older children

Praising effort NOT performance

Setting limits on behavior


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Establishing Rapport

the sense of mutual trust and harmonythat characterizes a good relationship

Good rapport = child/family perceives the clinician as

caring, interested, competent, and

trustworthy Clinician feels positive regard, genuineness,

and empathy

Necessary condition


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Use of communication skills

Acknowledgements

Descriptive Statements Reflections

Praise

Periodic Summaries Elaboration

Clarification


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Avoid:

Lack of interest or not attending

Sarcasm Lecturing

Interrupting

Commands No eye contact

Criticisms


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Interviewing

Types of interviews: Unstructuredallow child/parent to tell their

story

Semi-structuredprovide flexible guidelines, astarting point

Structuredmost often used to make diagnoses orin research studies, standardized

May interfere with rapport Does not provide info on family interactions or a

functional analysis of behavior

Which types of interview require the most clinicalskill??


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Explaining Confidentiality

Parents sign releases of information

Review concept of confidentiality and its limits

early in clinical interaction Limits to confidentiality:

Specific threat to someone else (homicidal ideation)

Self-harm is threatened (suicidal plan/intent)

Sexual and physical abuse (history or current)

Insurance requests

Courts

Generally referral source


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Interviewing Techniques

Establishing rapport is crucial Moving from open-ended to closed-ended

questions (general to specific)

Tell me about why youre here today? What about school is most difficult for you? Are you failing math because you didnt hand in

your homework.not studyingdidntunderstand the material?

Avoid Double-barreled questions (and, or) Long, multiple questions Leading questions

Psychological jargon


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Example DevelopmentalInterview

A. History of presenting problem

B. Prenatal, perinatal, and early postnatal history

C. Medical historyD. Acquisition of age-related milestones

E. School history

F.

Personality, social, emotional, behavioralhistory

G. Family history

H. Expectations about assessment visit


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A. History of presenting problem

Parental description of problem

Childs view of problem Onset

Duration

Interventions attempted Prior assessments

Parents sense of effects of problem, andsense of childs understanding


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B. Prenatal, perinatal, and early postnatalhistory

Pregnancy Labor and delivery

Birth weight

Apgar scores Complications post-birth


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C. Medical history

Across all ages

Accidents & injures Major illnesses

Ear infections

Neurological conditions Congenital and genetic conditions

Hearing and eyesight


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D. Acquisition of age-related milestones

Motor

Language

Toileting

E. School history

Preschool experiences to present Settings

Achievement, grades, strengths and weaknesses Behavioral, emotional, social functioning

IEPs, 504 Plans, accommodations, modifications

What teachers think


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F. Personality, social, emotional/mood, behavioralhistory across development

Temperament as an infant and toddler 2.5-5 years: Development of play, aggression,

interests

5-11 years: Hobbies, activities, friendships, family

relationships 11 to adolescence: Development of interest in opposite

sex, dating and sex, activities, drug and alcohol use,family relationships, self-concept, goals and aspirations


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G. Family history

Parental history: marriage(s), # children

Demographics, ages, education,occupation, SES

Siblings: ages, problems, school history

Medical, genetic, developmental,psychological, abuse problems

H. Expectations about assessment visit


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Developmental Considerations

Young children tend to think in concreteways, while teens may reflects more onfeelings and motivations

While age is an obvious indicator ofdevelopmental level, language and cognitivelevels may also vary with age

Interview format should be adjusted to theindividual childs level

Open vs. Closed questions


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Developmental Considerations

6 year olds might be asked about thedifference between preschool andkindergarten

Young teens might be asked about thetransition to individualized schoolschedules and homework, and peer

pressures. Older teens might be asked about

college, vocational plans, or separatingfrom parents


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Format of the Interview

Who will be interviewed is often aquestion with young patients

e.g., Children under 6 typically aregenerally interviewed with parents, thensometimes parents are seen alone

e.g., Older children and adolescents areoften seen as a family first and then latermay be interviewed alone

Sex abuse may be an exception


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Format of the Interview

If the clinicians sees family together itallows for:

Observation of interactional patternsAreas of agreement and disagreement

Tell family how their time will be

structuredAllow them to know if they can save

sensitive topics for when they are alone


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Closing the Interview

Summarize what has been learned Make sure you understand what the

interviewee has reported

Helps determine what additionalinformation might be needed

Ask the child/family if they have

questionsIs there anything else I didnt ask

about that you think it would be

important for me to know?


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Behavioral Observations

Psychological assessments always includeobservations about the patients behaviorduring the assessment

Collected throughout the assessment

Areas assessed/observed:

Orientation (person, place, time)

General appearance and behavior Gait, posture, dress, personal hygiene, activity level

Speech and thought

Coherence, speed, open vs. guarded


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General response style

Mood and affect

Euthymic vs. dysthymic Labile, blunted, etc.

Reactions to being evaluated

Response to encouragementAttitude towards self

Unusual habits, mannerisms,vocalizations


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How child relates to parent?

How child relates to examiner?

How child reacts to test materials ortoys?

Is the child age appropriate in

behavior?

How is the childs concentration?


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Are tantrums seen?

Does the child cooperate?

What is the extent of childs responses? short vs. elaborate

How is the childs speech and language

development?


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Informal Assessment

Self-monitoring records

Report cards

Personal documents Diaries, poems, stories

Role playing


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Multimodal Assessment

Obtaining information from severalsources

Integrate information from several sources Recognize limitations of any one source

Using several assessment methods

Assessing several areas of functioning Strengths and weaknesses


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Interpreting Results

Are test results congruent with otherinformation obtained?

How can you account for discrepanciesin teacher, parent, child reports?

Do findings appear to be reliable and

valid? INTEGRATING results from multiple

sources is a critical clinical skill


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Final Steps in Assessment

Develop intervention strategies andrecommendations

Write a report Provide feedback

Follow-up


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Key Ingredients

Successful assessment requiresknowledge of:

Psychological tests Psychopathology

Interviewing

Statistics

Development Hypothesis testing

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Child Psych Assessment

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